U.S. Senate committee learns that more than 1,100 service members took their own lives in just the past two years
Dr. Beth Zimmer Carter remembers her son as “vivacious, bright, funny and handsome,” who was fulfilling his dream of being an Army Ranger. But on Chris Carter’s first deployment to Afghanistan, he witnessed the gruesome deaths of his best buddy, his interpreter and a female Special Forces member.
“Chris sustained two close-range concussive blasts in that encounter, as well as numerous training blast exposures,” his mother testified last week before a Senate Armed Services subcommittee.
At the end of his Army commitment, Chris Carter was self-medicating with marijuana, which was legal in his state, to control anxiety and insomnia after mental health treatments failed.
When Chris admitted this to his command, he was demoted, made to do humiliating work, and confined to the post as his superiors initiated “other-than-honorable” discharge proceedings.
Devastated and dealing with PTSD, Chris Carter attempted suicide for the first time.
Beth Carter said after her son’s hospitalization, his Army commanders resumed restrictions: prohibiting him from leaving the compound, forbidding any socialization, and cancelling his Christmas leave as they continued discharge proceedings.
Chris was required to re-enlist for another year during the wait for his medical board determination.
“The morning of his death, I knew Chris was severely struggling while on duty, and I attempted to contact his superiors to notify them and request their assistance,” Carter continued. “Even though I am a retired Army commander, I was told “the command speaks to soldiers, not moms.”
Chris Carter died by suicide Feb. 12, 2015. His family buried him on his 23rd birthday.
Dr. Carter, a family physician, told members of the subcommittee that the military had multiple opportunities to help her son, and should have recognized the warning signs.
Instead, their actions increased his suicidal risks.
Carter said the military must do more to destigmatize and improve access to and use of mental health care.
Military medicine should require mandatory annual mental check-ups just like physical check-ups. Commanders who stigmatize, isolate, and punish those who are seeking help should be held accountable, Carter explained. “[Chris] was an extraordinary young man with a bright future and will be forever loved and missed.”
“It will come as no surprise that we have a mental healthcare crisis in this nation. The demand for mental health services far exceeds the supply of mental health care providers,” said Sen. Thom Tillis (R-NC) the ranking Republican on the panel.
The Health Resources and Services Administration estimates by 2025 the nation will have a shortage of 250,000 mental health professionals.
“While this subcommittee can’t fix these problems for the nation, we can look to improve access to mental health in the military health system.”
Chris Ford, a 20-year Air Force veteran, leads the Durham-based nonprofit Stop Soldier Suicide. Stop Soldier Suicide served more than 1,000 clients last year.
Ford told the senators that since 2001, more than 120,000 service members and veterans have died by suicide. “Leading research indicates each suicide affects 135 lives; meaning these untimely deaths have affected more than 16 million Americans in the last two decades — two times the population of New York City,” testified Ford.
These deaths are most common among young men, age 18 to 34.
Military response comes up short
Ford believes leaders at the Department of Defense must place mental fitness on the same level physical fitness.
But at some installations service members must wait weeks to get help, according to Ford.
Like Dr. Carter, Ford recommended annual behavioral health checkups. Those found not to be “mission ready” should receive timely, confidential and relevant care, not punishment.
More than 70% of all service member and veteran suicides are by firearm. Putting time and distance between firearms and service members experiencing stressful events or crises can reduce suicides dramatically, Ford noted in his prepared remarks. “Just like our aspirations to rid cancer from this planet, so too, should we aspire to eliminate suicide from the US military.”
“This is a shared challenge. Nationwide, suicide rates are alarming,” said Dr. Karin Orvis.
The director of the Defense Suicide Prevention Office (DSPO) within the Department of Defense said in the 2021 calendar year, 518 service members died by suicide. Orvis told the Senate Armed Services subcommittee the past two years have presented the nation with multiple challenges with service members and their families experiencing heightened stress, anxiety and disconnectedness.
The DSPO is working to address suicide through a holistic public health approach that involves military leaders, family, peers, spouses, chaplains and clinical care at the individual level.
Last month the Secretary of Defense directed the creation of the Suicide Prevention and Response Independent Review Committee, which will conduct a comprehensive review of the Department’s efforts to prevent suicide. That committee will visit nine installations in the coming months, including Camp Lejeune and the North Carolina National Guard.
Dr. Orvis said their independent recommendations will help inform change across the military to prevent future tragedies. In addition, the office is funding a new research study on the messaging surrounding the safe storage of both military-issued and personal firearms.
“Our data tells us that suicide is often a sudden and impulsive act. Adding time and distance between an individual’s suicide risk and a lethal means can be life saving.”
Dr. Murali Doraiswamy, a professor of psychiatry and medicine at Duke University School of Medicine, told the Senate subcommittee he shares many of the same concerns about the rising suicide rates of enlisted service members. “One metric that has not been mentioned is suicidal ideation or suicidal thoughts,” Doraiswamy said.
At the peak of the pandemic, the CDC estimated that nearly 1 in 4 young adults were experiencing suicidal thoughts.
“That’s roughly 30 million Americans. If those thoughts don’t abate and persists or increase over time, then we can expect to see a further increase in suicide rates in coming years,” Doraiswamy said.
Over half of those who attempt or commit suicide have never sought professional help.
“This is the group I feel we have not paid attention to,” he said.
Dr. Doraiswamy said young men are the least likely group to seek help through traditional pathways. Stigma, career impacts, and a fear of being seen as “falling short” are key reasons they don’t ask for help.
Questionnaires that service members may perceive as having punitive consequences discourage truthful answers during transition or enlistment, he warned.
So what does help?
Dr. Doraiswamy said that smartphones and web-based tools can provide confidential access to digital health that young adults desperately need. “Surveys show that young adults are much more comfortable with text messaging of WhatsApp or Instagram than making or receiving phone calls. They are more willing to reveal mental health information on digital surveys or even to a chat bot than a human clinician.”
One positive takeaway from the pandemic is that it resolved a decades-old debate over the value of virtual medical visits, according to Doraiswamy.
By relaxing HIPAA regulations, telehealth became essential and no-show rates improved in some cases by 50%.
Doraiswamy told senators there are many effective digital tools that now need to be scaled to increase access to mental health services.
“I want to highlight one-success story – Crisis Text Line. The number is 7-4-1-7-4-1, which is the easiest numbers you can find on your smartphone,” he continued. “It’s a U.S. based nonprofit which provides free 24/7 counseling to young people in crisis throughout the United States via text messages or WhatsApp.”
Live, trained crisis counselors receive a text and respond from a secure online platform. It has facilitated 100 million messages over five years and trained 20,000 crisis counselors, Doraiswamy said. “Over half of its users had never spoken to any other mental health professional.”
Those using the service were most likely to reach out because of relationship issues, depression or sadness — many of the same issues facing enlisted men.
And while there hundreds of promising technologies and commercial apps in the mental health field, regulations and incentives are not aligned to generate the high-quality evidence researchers hope to study in the future.
Doraiswamy said only four apps have earned FDA approval to treat mental health disorders. “I am not suggesting technologies replace face-to-face or the human touch, but they can serve as a bridge between what we have and what we need to have so that people can get the care anytime, anywhere.”
Doraiswamy has recommended the Department of Defense take a leadership role is evaluating such digital tools to understand where they can contribute the most and who was not served well by this approach. Doraiswamy believes the Defense Department’s study of such analytics would help millions of other Americans.
“Most of us cannot think of life without the internet, digital cameras or GPS, all innovations pioneered and implemented by the military first. I believe the DoD is similarly uniquely positioned to bring human values and the digital revolution together to save lives.”